Provider Demographics
NPI:1881289072
Name:RAWLS, CARRIE BEATRICE
Entity type:Individual
Prefix:
First Name:CARRIE
Middle Name:BEATRICE
Last Name:RAWLS
Suffix:
Gender:F
Credentials:
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:3303 3-F AIRLINE BLVD
Mailing Address - Street 2:
Mailing Address - City:PORTSMOUTH
Mailing Address - State:VA
Mailing Address - Zip Code:23701-3303
Mailing Address - Country:US
Mailing Address - Phone:804-365-2102
Mailing Address - Fax:
Practice Address - Street 1:3303 3-F AIRLINE BLVD
Practice Address - Street 2:
Practice Address - City:PORTSMOUTH
Practice Address - State:VA
Practice Address - Zip Code:23701-3303
Practice Address - Country:US
Practice Address - Phone:804-365-2102
Practice Address - Fax:
Is Sole Proprietor?:Yes
Enumeration Date:2021-03-09
Last Update Date:2023-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier